Complication rates of open transvesical prostatectomy according to the Clavien–Dindo classification system

Background: Traditional open prostatectomies either transvesical or retropubic remains the reference standard for managing benign prostatic enlargement in some centers, especially in developing countries. The comparison of complication rates between the various types of open prostatectomies is usually a source of significant debate among urologists, most times with conflicting results. The Clavien–Dindo classification system is an excellent attempt at standardization of reporting complications associated with surgeries. Materials and Methods: We reviewed retrospectively the records of patients who had open transvesical prostatectomy (TVP) in three specialist urology centers in Anambra state, Southeast Nigeria, over a period of 5 years (January 2004–December 2009), with the aim of documenting medical and surgical complications arising from open TVP. These complications were then categorized according to the Clavien–Dindo system. Results: A total of 362 patients had open TVP over the period under review. Of this number, 145 had documented evidence of complications. The mean age of the patients was 66.3 years (SD 9.4 years; range 49–96 years). The mean follow‑up period was 27.8 months (SD 12.6 months; range 6–33 months). The overall complication rate for open TVP in this study was 40.1% (145/362). Complication rates for grades i, id, ii, iiia, and iiib were 0.8%, 0.6%, 35.1%, 0.6%, and 3.0%, respectively. Most complications of open TVP occur in the early postoperative period. Conclusion: Open TVP still remains a valid surgical option in contemporary environment where advanced techniques for transurethral resection of the prostate and laparoscopic prostatectomy are unavailable. Most complications occur in the early postoperative period, with bleeding requiring several units of blood transfusion accounting for the commonest complication. This should be explained to patients during the preoperative counselling.Keywords: Classification, postoperative complications, reference standard, suprapubic prostatectomyNigerian Journal of Clinical Practice •Jan-Mar 2012 • Vol 15 • Issue

Success of nephron-sparing surgery in the treatment of localized renal cell carcinoma

Advancement in imaging techniques has now made it possible for small renal tumors to be detected incidentally. This has led to the use of minimally invasive techniques for treatment of these cases. A 33-year-old woman was diagnosed to have a small renal mass after routine abdominal ultrasonography for epigastric discomfort. Computed tomography scan was used to characterize the mass, and an elective partial nephrectomy was successfully carried out. The procedure is safe, less morbid, and has good oncological outcome

Traumatic penile injuries: Mechanisms and problems of treatment in a tertiary institution in Nigeria

Background: Penile injuries are uncommon. The more severe injuries are often difficult to manage.Objectives: We report our experience with penile injuries from different causes and treatment options available. Patients and Methods: We analyzed retrospectively 23 cases of penile injuries presenting to the Urology Unit of a tertiary hospital in the Southeastern part of Nigeria from January 2007 to December 2012.Results: The management for each patient varied depending on the nature and extent of the injury. The mean age of the patients was 28.9 ± 14.4 years (range 3 weeks to 43 years). The mean duration before presentation was 22.7 ± 17.8 h (range 1–168 h). The causes of penile injuries were categorized as follows: Postcircumcision 3 (13.0%), genital mutilation (self‑inflicted injury/attacks by assailants) 6 (26.1%), accident 4 (17.4%), penile fracture 8 (34.8%), and gunshot injury 2 (8.6%). Isolated blunt injuries to the corporal tissues as occurs in penile fractures was managed successfully with early exploration and closure of the tunical tear, while injuries to the penile skin was managed with dressing and secondary closure. Severe penile injuries resulting in partial or total phallic loss presented the most challenge to treatment.Conclusion: Traumatic penile injuries are not common. Severe penile injuries could be challenging because of the nature of the injuries, delayed presentation and unavailability of modern technological tools and experience required for the treatment of such severe injuries. Expertise in the use of flaps for a neophallus are still been developed, and penile prosthetic devices are not readily available in our setting.Key words: Injuries, management, penile, traumati

Diagnosis of prostate cancer with needle biopsy: Should all cases be biopsied before treatment?

Background: The triad of digital rectal examination (DRE), serum prostate specific antigen, and transrectal ultrasound‑guided prostate biopsy is used in the detection of prostate cancer (PCa). It is recommended that all cases of PCa should be diagnosed with needle biopsy before treatment. The exclusion criteria for those that may not be suitable have not yet been defined. Materials and Methods: We reviewed all the patients diagnosed with PCa at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Southeast, Nigeria, from January 2007 to December 2010. Relevant biodata and method of diagnosis of PCa before treatment were reviewed. Results: A total of 133 patients had bilateral orchidectomy over the period. 120 (90.2%) had their diagnosis confirmed by needle biopsy before bilateral orchidectomy (category 1), while 13 (9.8%) had bilateral orchidectomy before diagnosis was confirmed. The method of diagnosis for category 1 patients was with lower urinary tract symptoms (LUTS), abnormal DRE findings, elevated prostate‑specific antigen (PSA), and transrectal needle biopsy. For category 11 patients, diagnosis of PCa was suspected based on LUTS, abnormal DRE findings, and elevated PSA. Of this number, 11 (84.6%) had, in addition, sudden onset paraplegia at presentation, while 2 (15.4%) had severe uncontrolled hematuria at presentation. All the patients in both categories had needle biopsy confirmation of their disease. The sensitivity of PSA was 99.2%. Conclusion: Needle biopsy of the prostate is the preferred method for the diagnosis of PCa in most cases before treatment is undertaken. There are valid reasons why all PCas will not be diagnosed in this fashion. Elevated PSA when combined with an abnormal DRE finding increases the predictive value for cancer. In areas where pathologists are lacking, abnormal DRE and elevated PSA results can be a guide to proceed to treatment especially, where there is severe compromise of patients’ quality of life due to symptoms of advanced PCa while awaiting confirmation.Keywords: Bilateral orchidectomy, needle biopsy, prostate cancerNigerian Journal of Clinical Practice •Jan-Mar 2012 • Vol 15 • Issue

Schistosomal stricture of the ureter-diagnostic dilemma

Chronic schistosomiasis of the urinary tract can present with symptoms unrelated to the disease. A 33-year-old man from Edo State Nigeria presented with recurrent left flank pain. Laboratory investigations did not reveal any cause. Radiological investigation revealed a stricture of the left ureter and hydronephrosis of the left kidney. Management included surgical excision and antischistosomiasis chemotherapy. Histopathological examination of specimen of the ureter obtained after surgical exploration revealed Schistosoma heamatobium ova in the wall of the ureter

Patterns of superficial venous arrangement in the cubital fossa of adult Nigerians

Background: The cubital fossa is a common site for the removal of venous blood for analysis, transfusion, and intravenous therapy. The superficial venous return from the upper limb follows two or three major superficial veins, which are extremely variable; these include the cephalic, basilic, median cubital, and antebrachial veins and their tributaries.Objective: This anthroposcopic study was to determine the patterns of superficial venous arrangement in the cubital fossa of adult Nigerians.Materials and Methods: One hundred and thirty.five subjects (100 males and 35 females), aged between 20 and 27 years, were studied. The judgment sampling technique was employed. A tourniquet was firmly tied at the midarm level and the conspicuous superficial veins were diagrammatized and photographed with a camera.Results: Ten types of venous pattern arranged in six groups were noted. The most common pattern observed was the median antebrachial vein, dividing into median cephalic and median basilic veins, which join the cephalic and the basilic veins, respectively, with a variation. The result showed bilateral difference between the incidence of each type in males and females with the male values being statistically higher (P < 0.05).Conclusion: Appreciation of these venous patterns is useful to the medical and paramedical workers, especially in conditions that require venepuncture.Key words: Arrangement, cubital fossa, superficial vein

Evaluation Of Surgical Castration For Prostate Cancer At Nnewi: Issues Regarding Follow-Up Of Cases

Objective. To evaluate the average time of follow-up of patients with advanced prostate cancer after surgical castration and to assess the difficulties associated with follow-up of patients Patients and Methods. 89 case notes of patients who had surgical castration for advanced prostate cancer were reviewed. Information on age, PSA values, tumor differentiation and the duration of follow-up were analyzed. Patients who failed to return for follow-up one year after their scheduled appointments to hospital were assumed lost to follow-up. Results. The peak age incidence of the disease was in the 8th decade of life representing 43% of cases. The mean age was 69 ± 3.6years with a range of 40-89 years. 95.5% 0f the patients had associated co-morbidities. The commonest was hypertension (42.7%) followed by diabetes mellitus (28.1%). Others included arthritis (6.7%), hemorrhoids (6.7%), pneumonia (3.4%), asthma (3.4%), congestive cardiac failure (2.2%), inguinal hernia (2.2%), chronic obstructive airway disease (2.2%) and cataract (2.2%). 3.4% (3) had PSA values between 0-4ng/ml, 11.2% (10) had values between 5-9ng/ml, 20.2% (18) had values between 10-19ng/ml and 65.2% (58) had PSA values >20ng/ml. 44.9% (40) were poorly differentiated adenocarcinomas, 38.2%(34) were moderately well differentiated and 16.9%(15) were well differentiated adenocarcinomas. 9% of the patients were still on follow-up as at the time of conclusion of this study, 87.5% were lost to follow-up. 3.3% where confirmed dead. The average duration of follow-up for patients with poorly differentiated tumors was 8.5 ± 2.1months (range 1-24months), while that for moderately well differentiated tumors was 22.5 ± 5.8months (range 1-36months) and 36.6 ± 16.1months (range 24-60 months) for those with well differentiated tumors. Conclusion. This study highlights the difficulties associated with follow-up of patients with prostate cancer. The study shows that most of the patients are usually lost to follow-up after surgical castration. Assessment of survival after surgical castration for prostate cancer as well as deaths rates associated with prostate cancer may be difficult to assess in this environment. Keywords: Surgical castration, follow-up, Co-morbidities. Tropical Journal of Medical Research Vol. 12 (1) 2008: pp. 38-4

Retrobulbar Metastasis Of Prostate Cancer: A Case Report

A case of retrobulbar metastasis of prostate cancer in a 58years old man without lower urinary tract symptoms is reported. He presented with a two months history of protrusion of the right eye, diplopia and pain in the eye. Digital rectal examination revealed a mildly enlarged prostate that was hard in consistency and nodular. Prostate specific antigen estimation showed a value of 32.5ng/ml. a trans-rectal digitally guided biopsy of the prostate confirmed the diagnosis of adenocarcinoma of the prostate. Total androgen blockade was instituted with bilateral orchidectomy and bicalatamide 50mg daily. Response was complete but short-lived for 6months. Conclusion: We conclude that prostate cancer can present with bizarre symptoms sometimes unrelated to the lower urinary tract. We therefore, advice a thorough physical examination, including a digital rectal examination and prostate specific antigen determination in men above 50years presenting with unexplained symptoms. Keywords: Total androgen blockade, diplopia.Tropical Journal of Medical Research Vol. 11 (2) 2007: pp. 41-4

Cancer Of The Prostate: Experience At Nnewi, Southeast, Nigeria

Objective: To evaluate the clinical presentation, method of diagnosis, treatment and outcome of prostate cancer patients. Patients and Methods: A 5-year retrospective study of all patients seen with the diagnosis of cancer of the prostate at the Urology Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi from January1, 1996 to December 31, 2000. The demographic pattern, clinical features, laboratory findings, treatment modalities and outcome were studied. Results: A total of 54 cases were seen. Cancer of the prostate was the commonest urological tumour accounting for 77.1%. There was a 4-fold increase in annual incidence between 1996 and 2000. Mean age was 71.0+10.9 years with a range of 44-92 years. Average duration of symptoms before presentation was 8 months while the commonest mode of presentation was Lower Urinary Tract Symptoms (LUTS). Digital Rectal Examination (DRE) had a predictive value of 66.7%. PSA was obtained only in 17 patients. Values of < 4ng/ml was obtained in 11.7%, values between 4-10ng/ml in35.2%, between 10-20ng/ml 5.8% while 47.1% had values above 20ng/ml. Biopsy obtained in 14 patients showed poorly differentiated adenocarcinoma in 78.6%, well differentiated adenocarcinoma in 7.1% while 14.3% were unclassified. Commonest mode of treatment was bilateral orchidectomy in 46.3%. Follow up was variable from 3months to 6 years. Mortality was 22.2% while 33.3% were lost to follow up. Conclusion: Prostate cancer is a major problem facing the aging male. Inadequate facilities make early detection difficult. Treatment is mainly palliative because of late presentation. Key Words: Prostate cancer, Incidence, Presentation, Diagnosis, Palliation. Nigerian Journal of Clinical Practice Vol. 7(2) 2004: 65-6